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Ethically Treating PTSD Resulting from Terrorism and other Traumas
Ethically Treating PTSD Resulting from Terroism and other Traumas

Section 7
Challenges in Victims of Violent Crimes

CEU Question 7 | CE Test | Table of Contents | PTSD
Counselor CEUs, Psychologist CEs, Social Worker CEUs, MFT CEUs

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Next let's look at the Psychopathology of Being Held Hostage.

According to Hillman, the taking of hostages has become an unfortunate but familiar part of the contemporary sociopolitical climate both nationally and internationally. There are few scientific studies of the psychology of the hostage experience and a reflection of the conditions until recent times. Psychological studies of stress usually have focused on prisoners of war and concentration camp victims. These studies have emphasized the length of time in captivity, physical injury, and nutritional problems as the conditioned variables of stress in the subsequent development of psychiatric symptoms.

The hostage experience differs from either prisoner of war or concentration camp experiences in several ways.

Contemporary firsthand accounts by hostages indicate that the ordeal of being held hostage, even for a relatively short time, can have profound psychological consequences. The psychopathology of the hostage experience, for example in the case of a skyjacking, is important in understanding hostage behavior and in treatment considerations.

To further examine PTSD resulting from terrorism and other traumas, let us examine the psychological state of the fourteen correctional officers held hostage during the worst prison riot in U.S. history. As this case study in terrorism is detailed, ask yourself if one of the hostages were to become my patient or client, what specific interventions would I use, and how would these interventions differ or be the same from interventions I have used with other victims of violent crimes I have treated? What would my body language be like?As you listen to this case study, also ask yourself what ethical issues might arise?

3 Challenges of Victims of Violent Crimes

We will examine three areas:
1. Their feelings of Helplessness
2. Existential Fear
3. Sensory Input Overload.
The purpose is to give you an insight into the hostage experience.

Prison Riot
Seventeen officers in all were captured at a Penitentiary in New Mexico near Santa Fe. The riot had progressed quickly; in twenty-two minutes, inmates gained control of the penitentiary. For the next thirty-six hours, they rioted and killed thirty-three fellow inmates; ninety others were seriously injured.

The correctional officers examined were all Spanish-Americans who ranged in age from eighteen to fifty-four years.

Let’s examine the psychological state of the correctional officers who felt a combination of feelings of helplessness, existential fear, and sensory input overload. Let us look at these three, more specifically, in terms of the DSM classification of PTSD.

Challenge #1 - Helplessness
As you know, according to the DSM a criteria for PTSD is the patient has experienced or witnessed or was confronted with an unusually traumatic event that has both of these elements. The event involved actual or threatened death. Secondly, the patient feels intense fear, horror, or helplessness.

Total and profound helplessness was felt by all the hostages. This feeling was reinforced, in certain cases, when the guards were bound hand and foot and blindfolded. They quickly learned that there was nothing that they could do. If they complained in any way, they were bound more tightly or beaten severely. Those who were blindfolded had no way of knowing when or from where the next physical assault might come. The feeling of helplessness was emphasized by their separation from their fellow officers.

One guard thought of escape during his first hour of captivity. But when he heard some inmates kill another inmate in the cell adjacent to where he was being held, he gave up the idea in total hopelessness. Two guards who were beaten early during their captivity stated that the feeling of helplessness came to them almost immediately. One guard, who remained in hiding throughout the riot, felt trapped and helpless when he heard the inmates searching for him.

None of the officers could offer any resistance. However, being totally helpless had some positive aspects. Even under extreme provocation and abuse, the guards did not reveal certain information; they recognized that doing so would make no difference in their fate. One hostage, who was severely beaten, emphasized that he tried to keep “calm.”

At times he thought he was lucky that he was being hit rather than being stabbed. He took all of the blows and realized that he could not fight back, so he tried to remain calm. Another officer, who said that he felt “like a helpless lame duck,” recalled that a member of the “execution squad” praised him for calmness. The inmate then told the officer that he had a “ninety-nine percent chance of not getting out of the penitentiary alive.” His state of helplessness contributed to what appeared to be a stoical attitude.

As you know in skyjackings connected with and following September 11th, the helplessness of many passengers has been replaced by individual acts of heroism.

Challenge #2 - Existential Fear
The second psychological state experienced by the hostages is that of fear. Ochberg has labeled the fear experienced by the hostages in such a way as to distinguish it from any ordinary fear. By calling it existential fear, the inference is the hostages were afraid of losing their existence. As you know, according to the DSM one criteria for PTSD is the patient repeatedly relives the event. I and my colleagues have found that the more intense the fear reaction the greater chance that intrusive recollections through thoughts and images will occur. Here’s an example of the thoughts and images the hostages at the penitentiary experienced.

The guards were certain that they would be killed. They thought of ways in which the convicts would kill them; they pictured themselves being found dead after the riot was over. One guard described how he was hit and felt his head “throbbing with pain.” He thought he was going to die and that the inmates were going to rape him. He stated, “The inmates were all over, all around me, talking and screaming.” A few of the hostages were held by less violent inmates who attempted to protect them.

The inmates themselves became afraid, too, and gave the hostages clubs; they told them, “If we have to bump heads, we’ll need your help.” A new wave of existential fear for existence engulfed both the hostages and their inmate-guards with each visit from the execution squads. Existential fear may be a good descriptor for the feelings experienced by skyjacking passengers.

This frightening situation was reinforced by the prisoners’ repeated threats to kill the guards. Threats and evidence of physical violence and chaos of the situation reinforced the hostages’ fear. Take a minute now to recall a PTSD patient whom you have treated.

Ask yourself what was the fear component of their syndrome, and how did the extent of their fear affect their treatment? Would the term existential fear apply?

Challenge #3 - Sensory Input Overload
Thirdly, let us look at sensory input overload that occurs in the traumatic event of this hostage situation. The guards were held in a setting with a constant and high sensory input. The air was foul with smoke, and water from broken pipes flooded the floors. The winter chill came in through broken windows. Masked and armed convicts, traveling in groups, issued threats to all that came in their path. There was the continual noise from the destruction of the penitentiary, and the guards could hear the screams of inmates.

None of the guards became accustomed to this sensory overload. Each scream of terror or noise of destruction produced a new startled reaction and a wave of existential fear. The vivid scene during the time the officers were held hostage would come back after their release. In keeping with the PTSD criteria, any association with the riot would bring back thoughts and feelings experienced inside the penitentiary.

In regard to the DSM physiological reactions criteria: during their capture, the guards reported a variety of physical reactions to their state of fear and helplessness. Almost all experienced dry mouths and insomnia; most were unaware even of the need for sleep. None were hungry. Those who were physically harmed reported that their bodies felt numb. As you know, one of the DSM criteria is feelings of detachment. Thus, this detachment process appears to be starting even during the traumatic event.

Also, regarding sensory input overload, all the hostages described their mental conditions as dazed or in a state of shock. While they were being rescued, two of the older guards, who knew the prison well, did not know how they got out.

Fear and helplessness produced a pseudo-rational state whereby the hostage responded unquestioningly to any command. As an example, one hostage, who was released during the riot, turned around and almost reentered the penitentiary when an official on the outside told him to go back.

Peer-Reviewed Journal Article References:
Carsky, M. (2020). How treatment arrangements enhance transference analysis in transference-focused psychotherapy. Psychoanalytic Psychology. Advance online publication. 

DeTore, N. R., Gottlieb, J. D., & Mueser, K. T. (2021). Prevalence and correlates of PTSD in first episode psychosis: Findings from the RAISE-ETP study. Psychological Services, 18(2), 147–153.

Eagle, G., Benn, M., Fletcher, T., & Sibisi, H. (2013). Engaging with intergroup prejudice in victims of violent crime/attack. Peace and Conflict: Journal of Peace Psychology, 19(3), 240–252.

Grych, J., & Hamby, S. (2014). Advancing the measurement of violence: Challenges and opportunities. Psychology of Violence, 4(4), 363–368. 

Kaufman, J. S., Allbaugh, L. J., & Wright, M. O. (2018). Relational wellbeing following traumatic interpersonal events and challenges to core beliefs. Psychological Trauma: Theory, Research, Practice, and Policy, 10(1), 103–111.

Shubs, C. H. (2008). Transference issues concerning victims of violent crime and other traumatic incidents of adulthood. Psychoanalytic Psychology, 25(1), 122–141. 

Veira, Y., Finger, B., Schuetze, P., Colder, C. R., Godleski, S., & Eiden, R. D. (2014). Child behavior problems: Role of cocaine use, parenting, and child exposure to violence. Psychology of Violence, 4(3), 266–280. 

Online Continuing Education QUESTION 7: What produces a pseudo-rational state whereby the hostage responded unquestioningly to any command? To select and enter your answer go to CE Test.

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